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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Doxycycline compared with prednisolone therapy for patients with bullous pemphigoid: cost-effectiveness analysis of the BLISTER trial
British Journal of Dermatology, Volume 178, No. 2, Year 2018
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Description
Background : Bullous pemphigoid (BP) is an autoimmune blistering skin disorder associated with significant morbidity and mortality. Doxycycline and prednisolone to treat bullous pemphigoid were compared within a randomized controlled trial (RCT). Objectives : To compare the cost-effectiveness of doxycycline-initiated and prednisolone-initiated treatment for patients with BP. Methods : Quality-of-life (EuroQoL-5D-3L) and resource data were collected as part of the BLISTER trial: a multicentre, parallel-group, investigator-blinded RCT. Within-trial analysis was performed using bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective. Results : In the base case, there was no robust difference in costs or QALYs per patient at 1 year comparing doxycycline- with prednisolone-initiated therapy [net cost £959, 95% confidence interval (CI) −£24 to £1941; net QALYs −0·024, 95% CI −0·088 to 0·041]. However, the findings varied by baseline blister severity. For patients with mild or moderate blistering (≤ 30 blisters) net costs and outcomes were similar. For patients with severe blistering (> 30 blisters) net costs were higher (£2558, 95% CI −£82 to £5198) and quality of life poorer (−0·090 QALYs, 95% CI −0·22 to 0·042) for patients starting on doxycycline. The probability that doxycycline would be cost-effective for those with severe pemphigoid was 1·5% at a willingness to pay of £20 000 per QALY. Conclusions : Consistently with the clinical findings of the BLISTER trial, patients with mild or moderate blistering should receive treatment guided by the safety and effectiveness of the drugs and patient preference – neither strategy is clearly a preferred use of National Health Service resources. However, prednisolone-initiated treatment may be more cost-effective for patients with severe blistering. © 2017 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.
Authors & Co-Authors
Chalmers, Joanne R.
United Kingdom, Nottingham
University of Nottingham
Nunn, Andrew J.
United Kingdom, London
University College London
Kirtschig, Gudula
United Kingdom, Nottingham
University of Nottingham
Wojnarowska, Fenella T.
United Kingdom, Oxford
University of Oxford
Whitham, Diane J.
United Kingdom, Nottingham
Queen's Medical Centre
Schmidt, Enno G.
Germany, Lubeck
Universität zu Lübeck
Harman, Karen Elizabeth
United Kingdom, Leicester
University Hospitals of Leicester Nhs Trust
Williams, Hywel C.
United Kingdom, Nottingham
University of Nottingham
Statistics
Citations: 11
Authors: 8
Affiliations: 8
Identifiers
Doi:
10.1111/bjd.16006
ISSN:
00070963
Research Areas
Disability
Health System And Policy
Study Design
Randomised Control Trial
Study Approach
Quantitative